Basic Information
| Provider Information | |||||||||
| NPI: | 1013909498 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOSEPH | ||||||||
| FirstName: | SONIA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 E JACKSON AVE | ||||||||
| Address2: | MAILSLOT #83 | ||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724013119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702071630 | ||||||||
| FaxNumber: | 8702076581 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 E JACKSON AVE | ||||||||
| Address2: | MAILSLOT #83 | ||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724013119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702071630 | ||||||||
| FaxNumber: | 8702076581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 12/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 236183 | NY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | E7815 | AR | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 197351003 | 05 | AR | MEDICAID | 02657683 | 05 | NY | MEDICAID |